Clyde Dental Lab
(828) 627-2200 Kent Decker CDT
P.O. Box 526
166 Nelson Street Clyde, NC 28721 Date_________________
Dr.____________________________________________________________________
Address_______________________________________________________________
City_______________________________State_________Zip________
Patient________________________________________________Age______M__F
Tooth/Teeth___________________________________ Shade____________________
Type of Restoration/Instructions/Material
patient’s concerns:
reminder list:
(828) 627-2200 Kent Decker CDT
P.O. Box 526
166 Nelson Street Clyde, NC 28721 Date_________________
Dr.____________________________________________________________________
Address_______________________________________________________________
City_______________________________State_________Zip________
Patient________________________________________________Age______M__F
Tooth/Teeth___________________________________ Shade____________________
Type of Restoration/Instructions/Material
- pressed crown/veneer
- pfm
- porcelain butt margin
- full cast crown/inlay
- zirconia layered with porcelain
- full contoured zirconia
patient’s concerns:
reminder list:
- digital photos: pre-op, shade(s), prep shade, recommended views (video)
- horizontal leveling tool: bite stick
- bite: rigid bite material (ex. blu-mousse)
- impressions: full arch is preferred
- models: pre-op, opposing, approved temps
- measurements: measured lengths of approved temps from margin to inc edge (8 and/or 9) are better than models